NPIMap

Organization Active NPI

Roundys Supermarkets Inc

  • Community/Retail Pharmacy
  • Brookfield, WI
National Provider Identifier
1326291345
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8886-42 Issued in WI
Legal business name
ROUNDYS SUPERMARKETS INC
Practice address
17295 W Capitol Dr
Brookfield, WI 53045-2004
Phone
(262) 373-1080
Fax
(262) 373-1083
NPI assigned
Nov 4, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Allison Bredestege
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2155967Pick N Save Pharmacy #534-36817295 W Capitol Drive, Brookfield, WI 53045Certificate of waiverOct 8, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Roundys Supermarkets Inc17295 W Capitol Dr, Brookfield, WI 53045-2004(262) 373-1080 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Dec 18, 2023

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20080218000141 WI Part B Supplier - Mass Immunization (Roster Biller Only) 5698858470 This NPI is an additional NPI on the enrollment
O20100930072472 WI DME Supplier - PharmacyDME Supplier - Grocery Store 5698858470 Practice locations: Brookfield, WI

National Provider Directory

National Provider Directory
Tax ID family
Mariano'S Pharmacy (103 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 8886-42 WI Primary

Addresses

NPPES NPI Registry

Primary practice location

17295 W Capitol Dr
Brookfield, WI 53045-2004

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
1326291345MedicaidWI
2117682OtherPK

Other names 1

NPPES NPI Registry
  • PICK N SAVE PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 1, 2016.

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1326291345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17295 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452004",
            "telephone_number": "262-373-1080",
            "fax_number": "262-373-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "BREDESTEGE",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8886-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326291345",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117682",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PICK N SAVE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.